Speech Pathology Australia (SPA), Australia's professional organization for speech-language pathologists (SLPs), recently submitted a proposal that suggests that SLPs working in clinics run by the Australian government must be trained in the Lidcombe Program in order to treat pre-school aged children who stutter. SPA is also supporting legislation that would extend this mandate to private practitioners and require them to provide the Lidcombe Program in order to be reimbursed by Medicare. Although the SPA’s intentions may be to increase access to treatment for young children who stutter, we must not overlook the ramifications of having the government and private insurance companies intervene with clinical decision-making. The first thing to consider is that there are multiple factors that are known to contribute to the onset of stuttering. Each child has a unique set of abilities and vulnerabilities that determine if and how stuttering is going to persist. Those different circumstances demand different approaches to treatment. A speech pathologist cannot be expected to develop a treatment plan that is specifically tailored to the client when the SPA is using Medicare reimbursement to limit them to one approach. Speech pathologists could be faced with the unfortunate dilemma of deciding whether to use an approach that best fits the child and families’ needs or to use the approach that will get reimbursed.

Question: Do you have a sequence in which you like to introduce techniques to students who stutter?

I do not believe there is a "right" sequence. Each child and family experiences stuttering in a different way due to their temperament, home environment, communities, etc. and their treatment plan has to reflect that. However for new clinicians or clinicians who have little experience with treating a child who stutters, it is understandable that you may want a blueprint of what therapy should look like.

There are more than 3 million people in the United States who stutter. Pediatricians and teachers are often the first professionals that a parent will go to for advice. In order to determine when to refer to a speech/language pathologist, these professionals are faced with the challenge of differentiating between typical disfluencies and true stuttering.Research suggests that anywhere between 75 to 80 percent of children who go through a period of disfluency will outgrow stuttering. This statistic can often lead teachers and pediatricians to suggest that the family “wait and see” before consulting a speech/language pathologist.However, one must also consider the risk of missing a critical window in which treatment is optimal. Early intervention plays a vital role in reducing the likelihood that a child will continue to stutter and can minimize the impact of stuttering on a child’s life--both socially and academically. There are certain risk factors that professionals, as well as families, should consider when deciding what’s best for the child.

Very excited to be helping to facilitate a FRIENDS workshop on March 28, 2015 in Washington, D.C. There will be sessions for children, teens, siblings, parents and speech-language pathologists . You can learn more about this wonderful organization by visiting their website at http://www.friendswhostutter.org/.

When a child who stutters is demonstrating the ability to make changes to their speech in the therapy room, it seems obvious that they’d want to use the same strategies to improve their speech outside of the therapy room as well. Children, especially teenagers, rarely want to stand out in a way that can stigmatize them, provoke questions or increase the chances of teasing. The question then arises, “Why aren’t they using their tools?!” Speech and stuttering modification techniques are often learned quickly and easily within the therapy setting. However, speech/language pathologists and parents often feel discouraged when knowledge of these techniques seem to disappear as fast as it takes for the child to get to their car in the clinic’s parking lot. Is it laziness on the part of the child? Is it the fault of the family for not following through with home assignments? Is the speech/language pathologist not teaching the correct strategies? Instead of pointing fingers at each other, let’s uncover why speech/stuttering strategies can be difficult and determine how we can best navigate these challenges.

A careful diagnosis, thorough evaluation and an individualized care plan, are the keys to successfully treating the fluency disorder cluttering. The disorder is characterized by perceived rapid and/or irregular rate of speech, which results in reduced clarity and fluency.

"To the listener, the speech rate of a person with cluttering sounds rapid, or sounds rapid sometimes, then other times more typical," explained Kathleen Scaler Scott, PhD, CCC-SLP, BCS-F, assistant professor, Department of Speech-Language Pathology at Misericordia University in Dallas, Pa.

In the past, experts thought the rate of speech in this patient population was faster than average, but that is no longer the case, said Scaler Scott, who recently co-authored Managing Cluttering: A Comprehensive Guidebook of Activities, with David Ward, PhD, of the University of Reading, England.

While the person's speech might sound rapid or irregular to the listener, research now shows the rate of speech is often measured within normal limits, Scaler Scott told ADVANCE. "The current thinking is that a person with cluttering speaks at a rate that is too fast for their system to handle," she qualified.

According to Brooke Leiman, MA, CCC-SLP, people who clutter often demonstrate missed or collapsed syllables (e.g., "I went to the zoo," becomes "I went the zoo."), abnormal pauses or speech that contains abnormal rhythm or syllable stress. Leiman is director of the Stuttering Clinic at the National Speech/Language Therapy Center in Bethesda, Md., and host of www.stutteringsource.com.

People who clutter also demonstrate excessive "typical" or "non-stuttering-like" disfluencies, according to Leiman. A few examples of typical disfluencies include: phrase repetitions ("can I can I have a cookie?"); phrase revisions ("I want the-can I have the cookie?"); and interjections ("um").

If you had a chance to go back in time, would you do things differently? Is there advice you might give your younger self, knowing what you know now? Why not put it in writing? Simon Walsh, a person who stutters and the host of the blog "Diary of a Stutterer", did just that. After reading his post, I immediately knew I wanted to use this idea in my own therapy room. The purpose of this assignment is not to dwell on "mistakes" of the past, but rather to help identify all the positive changes that have been made. This is a fun way to get students talking about the consequences of previous unhelpful thoughts or habits so that if they were to reappear, which habits so often do, the student might be better equipped to identify and extinguish them. For younger students and students that are new to therapy, this assignment can be adapted by having them write a letter to their future self. Instead of focusing on how things have changed and what they have learned, instead this assignment allows students to ask questions they may have about stuttering and identify things that they want to change.

This is one of my favorite therapy activities! With permission from the student, I have posted an example of one of these letters. Do you have any similar activities you have done with your student, your child or something you did for yourself? Post below!

I have been getting a lot of questions from SLPs and parents that all seem to center around the question "Is this stuttering" or "Does this warrant speech services?"

Question: I am a school based SLP. I just screened a 7 year old girl. Her teacher was concerned that she might be stuttering. She is repeating whole words and phrases quite often. She also used some interjections such as "um". Her teacher has never heard her repeat or prolong sounds. Is this really considered stuttering if a child is only repeating words and phrases? I have been looking on the internet, but most children either repeat syllables or sounds as well as words or else they don't repeat whole words as often as this student.

I was interviewing for assistant positions at our summer speech and language camp when I first met Ben Goldstein. Ben is a graduate of the University of Maryland and was in the midst of taking his pre-requisite courses in order to apply for graduate school to become a speech pathologist. Ben also happened to be a person who stutters (PWS). As the interview continued he shared that he was introduced to Avoidance Reduction Therapy by Vivian Sisskin at the College Park campus of UMD. I had already been applying aspects of Avoidance Reduction therapy with my clients, however Ben helped solidify my feelings on this approach. Ben was kind enough to answer some questions and walk me through his experience with Avoidance Reduction therapy, which is included below.

Avoidance Reduction therapy is an approach to stuttering therapy that can be used with both school-aged and adult clients. This approach views stuttering as an approach-avoidance conflict; a theory that states that a PWS experiences the desire to speak and interact with others while simultaneously experiencing an urge to hide their stuttering. The result of these competing desires culminates in the maladaptive secondary behaviors that interfere with communication (ex. eye blinking, leaning forward, use of fillers, etc.). These competing desires also result in a feeling that one can not partake in certain activities and situations due to their speech.

Avoidance Reduction therapy works towards reducing these maladaptive behaviors, leaving in its place a more comfortable, forward moving form of stuttering. It also works towards reducing the handicap of stuttering, whereby increasing a person's willingness to participate in various activities and situations, whether or not they show some stuttering. Unlike other approaches that focus on fluency, this particular approach views a person's strong desire to be fluent as perpetuating the problem and ultimately what contributes to their word and situational avoidances, as well as much of the struggle behaviors you see in their speech. Avoidance Reduction therapy does not put an emphasis on fluency, but rather on improving a person's ability to successfully communicate in the "real" world.

How do you incorporate Avoidance Reduction therapy into your sessions? Start by helping your client to identify their own stuttering patterns and assist them in recognizing how much of their pattern is "true" stuttering and how much of what we see is actually habits they formed in an attempt to mask stuttering. Challenge clients to allow themselves to show true stuttering (or perhaps use voluntary stuttering), beginning in the safety of the therapy room and eventually branching out to different "real-life" situations. As you work through these challenges, clients will often discover ways in which their stuttering was holding them back that they may not have realized before. Read on to learn about Ben Goldstein's first-hand experience with Avoidance Reduction therapy.

Much like, cancellations and pull-outs, a prep set is a speech tool I use with clients as they gain the ability to monitor their speech. Prep sets help a person who stutters (PWS) make changes to their speech so that their speech can be more forward-moving and so that they can stutter more comfortably. Once a client demonstrates the ability to use cancellations and pullouts, I will introduce the idea of prep sets.

DISCLAIMER:The purpose of this website is to act as an educational aid and address common topics associated with stuttering. It is not intended to replace the need for services provided by a licensed speech pathologist who can tailor treatment to an individual's needs.